What Are You Smoking? Bacteria Found at Local Hookah Bars

Where has your mouth been? Or, better yet, where has the mouth that previously touched your hookah been? A team of researchers from UT, headed by Dr. Mary Martinasek, an assistant professor in public health, conducted field research on local hookah bars and found dangerous bacteria that can cause illnesses like oral herpes and tuberculosis.

On Saturday, Feb. 27, Zachery Rivera, a sophomore biology major, will present the research at the Florida Undergraduate Research Conference (FURC) held in Plant Hall. In March, the research will be presented by Martinasek in a teleconference with the FDA.

Studies on hookah smoking typically highlight the harmful effects caused by the smoke inhalation. For instance the Center for Disease Control warns, “The charcoal used to heat tobacco in the hookah increases the health risks by producing smoke that contains high levels of carbon monoxide, metals, and cancer-causing chemicals.”

Setting her study apart, Martinasek focused her own research on a different concern of hookah smoking: the levels of bacteria found in the different components of the pipes.

Martinasek, along with the assistance of Dr. Eric Freundt, an assistant professor in biology, began the project in the spring of 2015. She was awarded a grant for the research by the American Lung Association. When the project started, the team consisted of a mixture of public health students, under the advisement of Martinasek, and microbiology students, whom Freundt oversaw. Despite beginning with five student assistants, several have since graduated or exhausted their participation and, now, Rivera is the only student member remaining actively involved in the study.

The team devised a research plan, that was approved by the Institutional Review Board (IRB), and sent the trained student assistants to local hookah bars for data collection.

“We went in, ordered a hookah pipe and swabbed while we sat there,” Rivera said.

The student assistants swabbed one hookah pipe from each of 10 local bars, focusing on three components: the mouthpiece, the hose and the connector where the hose meets the base.

Due to the communal nature of hookah smoking, Rivera says that bacteria levels should be cause for concern, however “it’s not something that crosses your mind.” This research is unique because there has only been one other study conducted that analyzed bacterial contamination of hookah pipes (to Martinasek’s knowledge), but that study did not include field research.

The team analyzed the samples collected and conducted the polymerase chain reaction (PCR), which amplifies the DNA of the samples. Through this analysis, they grew bacteria from samples from all ten bars and found many pathogens, or agents that cause illnesses. The different pathogens discovered in these hookah pipes can lead to things like blood infections, food poisoning, skin infections, swelling of the heart, and a scarlet-like fever (a species of tuberculosis called yersinia pseudotuberculosis). Several of these bacteria are resistant to antibiotics. The data is kept anonymous, so the research team cannot specify which bacteria were found at which hookah bar. The Minaret reached out to six hookah bars in the area inquiring about their cleaning procedures but none responded for comment.

“Research has indicated that hookah smoking raises the risk of transmissible diseases such as tuberculosis, mononucleosis and oral herpes from sharing the mouthpiece and pipe, yet there is a dearth of research specific to bacterial contamination of hookah pipes,” Martinasek said. “Our research set out to answer the question of whether there is a concern of bacterial contamination from these devices at local hookah bars. Given our findings, our ultimate goal is to both educate those who participate in hookah smoking, but also to educate and encourage our county commissioners to consider policy implementation.”

The FDA also caught wind of the research and set up a teleconference with Martinasek to be held on March 18. Rivera and Freundt will be in attendance to assist with answering questions following the presentation.

“The FDA scientists will use the presentations to synthesize the health impact that hookah smoking is having on both those who participate in the behavior, those who work in the industry and those who may be exposed to the secondhand smoke,” Martinasek said. “From this workshop, the FDA will likely formulate and prioritize regulations surrounding hookah smoking which may include packaging, distribution and hookah bar regulations.”

While Martinasek will lead the presentation with the FDA, she has handed the reigns to Rivera for two upcoming conferences, including the FURC on Feb. 27 and, on March 4, UT is sending Rivera to present at the Society for Research on Nicotine and Tobacco (SRNT) annual meeting in Chicago.

“[Zach] has been involved in the project full circle,” Martinasek said. “Not only has it been fascinating to get frequent detailed updates from Zach about the microbiology findings, but to see the excitement and increased confidence in conducting research that this project has elicited in him.”

Martinasek has a background in the effects of smoking on health, working clinically as a registered respiratory therapist for more than two decades before pursuing her Masters and PhD degrees in public health.

“When I began teaching at UT in 2011, I decided to conduct a similar study with UT students and found that the rates of hookah smoking are much higher than those that I obtained from USF,” Martinasek said. “This motivated me into wanting to learn more about the behavior.”

Martinasek has worked with student assistants of all backgrounds in myriad smoking-related research studies, including conducting carbon monoxide readings of hookah bar patrons, collecting air quality samples inside of hookah bars, and analyzing particulate matter data. Martinasek is currently working with a subcommittee of the Healthy Spartans 2020 initiative to study the relationship between UT students and e-cigarettes.

While Martinasek has submitted written comments on hookah to the FDA before, this particular study is the first opportunity the team has had to share their most recent research in a panel session face-to-face with the FDA.

“I’m ecstatic to get to do all of this; the more I hear about the conferences, it’s a mixture of wanting to throw up and jump up and down and clap at the same time,” Rivera said.